- Background
Since 1944, Heifer International has worked with more than 43 million people around the world to end hunger and poverty while caring for the Earth. Working with rural communities in 19 countries in Africa, Asia, and the Americas, including the United States, Heifer International supports farmers and local food producers to strengthen local economies and build secure livelihoods that provide a living income.
Heifer started work in Kenya in 1981. Since then, Heifer Kenya has supported more than 682,000 families working in the dairy, meat, poultry, and horticulture value chains. Heifer Kenya is working with farmers to increase production and productivity by strengthening extension services and farmers’ cooperatives where they gain vital skills that enable them to scale and sustain their businesses. Heifer Kenya implements its projects through community development and enterprise development approaches. Each project focuses on three priorities: strengthening and diversifying the resource base, strengthening country program efficiency, and increasing outreach and impact through innovative value chain systems.
- Rationale
The current medical insurance term for the last period is ending. Heifer Kenya is seeking a reputable, licensed medical insurance provider to offer comprehensive coverage to its employees and eligible dependents. The objective is to provide quality, accessible, and cost-effective health care services that support employee well-being, productivity, and retention.
The insurance cover is expected to run for one year from 1 January 2027, with the option to renew, subject to satisfactory performance, budget availability and mutual agreement.
Objectives:
The objective of this procurement is to identify and contract a medical insurance provider capable of delivering comprehensive inpatient, outpatient, dental, optical, maternity, wellness, and related health care benefits to employees and their eligible dependents.
Scope of Services:
The successful insurer shall provide and administer a comprehensive medical insurance scheme including, but not limited to, the following services:
- Inpatient Cover
- Hospitalization expenses.
- Surgical procedures.
- Specialist consultations.
- Intensive Care Unit (ICU) and High Dependency Unit (HDU) services.
- Pre-existing and chronic condition management where applicable.
- Outpatient Cover
- General practitioner consultations.
- Specialist consultations.
- Laboratory and diagnostic services.
- Prescription medication.
- Physiotherapy and rehabilitation services.
- Maternity Cover
- Normal deliveries and Caesarean sections.
- Antenatal and postnatal care.
- Pregnancy-related complications.
- Dental Cover
- Routine consultations and examinations.
- Extractions, fillings, scaling, and polishing.
- Other approved dental procedures.
- Optical Cover
- Eye examinations.
- Prescription lenses and frames.
- Other approved optical services.
- Emergency Services
- Emergency treatment.
- Ambulance services.
- Medical evacuation where applicable.
- Wellness and Preventive Care
- Annual medical check-ups.
- Vaccinations
- Health education and wellness programs.
- Mental health and counseling services.
- Additional Benefits
- Last expense benefit.
- International emergency cover (if applicable).
- Chronic disease management.
- Telemedicine services.
- Fertility Treatment
- Major disease benefits
In addition, the successful insurer will provide access to high-quality health service providers in the major counties of operation, namely: Nairobi County, Laikipia County, Samburu County, Uasin Gichu County, Isiolo County, Kajiado County, Narok County, Nakuru County, Kiambu County and their environs.
Stakeholders:
- People Department
- All Staff- Beneficiaries of the service
Expected Beneficiaries
The insurer will provide coverage for:
- Organization employees.
- Eligible spouses.
- Eligible children and dependents as defined by the organization.
- A separate intern medical cover
Indicative Population
The proposed medical insurance scheme will cover approximately 130 lives, comprising 35 employees, 23 spouses, 70 children/dependents, and 2 interns.
3.0 Mandatory Requirements
If you're interested in our insurance companies, please meet the following mandatory requirements and provide the required supporting documentation.
- Regulatory Registration: Must be registered with the Insurance Regulatory Authority (IRA) to provide medical insurance coverage and submit a valid IRA registration certificate.
- Company Registration: Must submit a Certificate of Registration/Incorporation from the Registrar of Companies and demonstrate at least 15 years of operation.
- Tax Compliance: Must provide a valid Tax Compliance Certificate issued by the Kenya Revenue Authority (KRA).
- Industry Membership: Must provide a valid 2026 membership certificate from the Association of Kenya Insurers (AKI).
- Policy Exclusions: Must provide a comprehensive list of all inpatient and outpatient exclusions. Where no exclusions apply, written confirmation must be provided. Failure to submit either will result in disqualification.
- Annual Medical Premiums: Must demonstrate gross annual medical premiums of at least KES 1 billion for each of the last three years, supported by financial statements or records verifiable through the IRA.
- Reinsurance: Must provide approval from the IRA Commissioner for quota-share reinsurance arrangements.
- Paid-Up Capital: Must demonstrate gross paid-up capital of at least KES 1 billion for each of the last three years, supported by financial statements.
- Mandatory Scheme Compliance: Must explicitly confirm compliance or non-compliance with each of the following requirements:
- Inpatient and outpatient medical cover must be provided as one package under a single underwriter.
- Cover must include the principal member, spouse, and up to four child dependents. The principal member and spouse must be aged 18–65 years, while children must be covered from birth to 25 years. Children with disabilities must remain covered for as long as they depend on the principal member.
- Cover must include chronic, congenital and pre-existing conditions; HIV/AIDS; ambulance and air evacuation; maternity; dental and optical care; mental health and psychiatric treatment; and pandemics, under inpatient and outpatient benefits as applicable.
- Biometric identification systems must be provided at no additional premium.
- Members must have direct access to approved health care providers without mandatory referral through insurer-owned clinics.
- The policy cancellation notice period must be 60 days.
Note: Bidders must meet all mandatory requirements to proceed to the technical evaluation stage.
4.0 Technical Evaluation – 100 Marks
4.1 Corporate Experience, Financial Capacity and Provider Network – 30 Marks
TC1. Previous Experience – 10 Marks
Submit certified contracts or recommendation letters clearly indicating the total written premiums from corresponding clients or their brokers.
TC2. Countrywide Healthcare Provider Network – 7 Marks
Provide a list of approved health care providers across Kenya where the underwriter maintains active credit facilities. Heifer reserves the right to verify these arrangements directly with providers.
The stated geographical scoring bands are 1 mark for coverage in 1–15 counties, 2 marks for 16–30 counties, and 4 marks for more than 30 counties.
TC3. Audited Financial Statements – 2 Marks
Submit audited annual financial statements for 2023, 2024, and 2025.
TC4. Gross Premiums – 2 Marks
Demonstrate gross premiums of at least KES 2 billion over the last three years, excluding motor insurance premiums.
TC5. Corporate/Government Client Portfolio – 2 Marks
Provide evidence of three of the underwriter's largest current corporate or government medical insurance clients during 2024 and 2025, each having paid premiums of at least KES 100 million.
TC6. Health Education – 2 Marks
Commit to facilitating health talks at least twice annually.
TC7. Executive Medical Checkups – 5 Marks
Provide at least one annual executive medical examination for members and one spouse, including a personal one-on-one consultation with an executive health physician.
4.2 Quality of Service and Value Addition – 25 Marks
TR8. Service Delivery, Underwriting and Claims Management
Bidders should provide a clear description of their service delivery arrangements, including:
- Credit facility payment timelines: 30 days or less (4 marks), 45 days (2 marks), and more than 45 days (0 marks).
- A dedicated key account manager for Heifer (1 mark).
- Proposed schedule of wellness education and clinics (2 marks).
- Quarterly reporting schedule to Heifer (1 mark).
- Addition or deletion of scheme members within one working day (1 mark).
TR9. Value-Added Benefits and Extensions
Bidders should demonstrate additional benefits, concessions, wider coverage, or extensions beyond standard medical schemes, including:
- Proposed cover for premature babies born before 37 weeks (3 marks).
- Cover for dependents beyond Heifer's approved limits (M+5) (2 marks).
- Cover extending to East African countries and overseas during short-term visits (2 marks).
- Access to treatment outside Kenya (2 marks).
- Other unique value-added benefits (4 marks).
TR10. Cash Claims and Reimbursement – 4 Marks
Demonstrate provisions for reimbursement of cash claims where members access treatment in areas without approved providers or where a treating doctor is outside the insurer's panel, particularly where the member has an established treatment history with that doctor.
4.3 Medical Benefits and Sub-Limits – 45 Marks
Bidders must respond to the minimum benefit limits and sub-limits under both Options 1 and 2.
Full marks w...